It's all a bit scary !

I keep reading that you are all a nice bunch and I hope so.

here is my story - will try and keep it short !

I went to see my GP at the end of May as I had a persistant cough - being a 20 a day smoker I wasn't really looking forward to the lecture I was about to recieve. I walked out of the GP's with 2 inhalers and instuructions to return in a week.

I duly returned in a week (minus the cough) only to be given a course of steriods and an appt with the asthma nurse...... consultant appt. blood tests another course of steroids follows. the steriods improve my peak flow but maximum reading is 270 - don't know what it should be ?

the Drs keep talking about COPD versus asthma but which one ??

I always thought people with asthma have asthma attacks - I don't, I just often breathless and I don't have a cough anymore and have been off the fags for 9 weeks and 3 days !!!

Any advice would be welcome (back to the hospital in a couple of weeks)

LisaLou

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don't panic we are all different. i wouldn't say i have asthma attacks but cough and get short of breath and this last week or so have got bit wheezy saying that have just escaped after 4/52 in costa. people say you learn to know your symptoms in time and you will find many on here don't wheeze at all. good luck with your management and congrats giving up the fags. well done. as for pf everyone is diff as it goes off age and height,

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Hi LisaLou,

Thank you for calling us a nice bunch.... sorry you have had to join the nice bunch though!

Firstly, many, many congratulations for packing in the cigarettes - it's not easy, and it is by far the most important thing you can possibly do to improve your lung health and general health. So that is a brilliant start.

As for the asthma versus COPD question - that can be a difficult one to unpick, and it's perfectly possible that you have elements of both. I see from your profile that you are 35 - *most* people with smoking induced COPD develop it in their 5th decade, although it is possible to develop it younger. Most people will have been smoking at least 20 a day for at least 20 years to get COPD.

The main difference is that asthma is straightforward airway narrowing caused by contracting airway muscles (bronchospasm) and by swelling of the airway tissue (oedema) and mucus production. This obstruction is almost always reversible (often completely so), either spontaneously or with inhalers and so on, and is often triggered by specific things such as allergies, exercise etc. It is usual to wheeze with asthma, but it is perfectly possible to have asthma and not to wheeze or even be breathless, but just to have a cough (sometimes referred to as cough-varient asthma). It is also common not to experience 'attacks' as such.

Chronic Obstructive Pulmonary Disease is a bit more complex. It is an umbrella term describing a collection of diseases such as chronic bronchitis, emphysema, (both usually caused by smoking) and occasionally chronic severe asthma. The main feature of COPD is that the airway narrowing is not necessarily fully reversible. There is often some reversibility with reliever medications like salbutamol (Ventolin) but this is not usually as dramatic as with asthma. It is a progressive condition, but the good news is that stopping smoking dramatically slows the progression, and, in some cases, can reverse it. The symptoms tend to be breathlessness and a cough, which is often productive of sputum; wheeze is less common than with asthma, but can occur.

Making the distinction between the two can be hard. It is often a case of watching and waiting, assessing your symptoms and seeing how well you respond clinically and with peak flows to the treatment. They may decide to do lung function tests with a reversibility test, where they test your lung function (tiring but non-invasive and painless) and then give you some salbutamol and retest in a few minutes. The degree of improvement can help to distinguish between asthma and COPD.

The treatments for asthma and COPD are very similar, and it's likely that at first, certainly, they would be pretty much the same. If they do decide that there is a component of COPD, it might be worth asking about gene testing for alpha-1 antitrypsin deficiency, because of your young age - this is a gene that makes people more susceptible to COPD at a younger age, especially if they smoke. If you do have the gene it will not only be a sign for them to watch you more closely for problems, but could also be helpful for other family members who may be able to be closely monitored, stop smoking etc, if they know they are at higher risk.

Your predicted peak flow varies according to your age and height - at the age of 35 yours should be at least 420, more if you are tall, so you are still coming in a little low. (You can see a chart of predicted values at peakflow.com/top_nav/normal.... The inhalers and steroids will take a little time to work, though, so don't worry at the moment. Hopefully you will see it gradually come up over the next few days and weeks. It is important to remember, too, that the values are only 'predicted' values based on the population - some people do have lower values that are perfectly normal for them.

Hopefully, you will get some more answers, and some reassurance, over the days and weeks to come. I know it all takes time and it is frustrating and worrying - but you will get there in the end. I am not going to tell you to try and be patient, because I know I fail to be patient in that sort of situation myself! Just try to remember that the vast vast majority of people in your situation do find a combination of medication that can control their symptoms almost completely. And, as I said, you have already done the most important, and probably hardest bit - stopping smoking - so very well done for that.

Take care

Em H